Summer 4 Kids

Rockwood Summer Registration (Summer 4 Kids)

* Indicates required field

Childs Name *

First

Last

Birthdate *

Age *

Grade *

Parent or Guardian *

First

Last

Parent or Guardian *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Allergies? *

Yes No

What allergies do you have? *

What are you allergic to? *

Pictures *

Yes No

Comment *

Submit

Office Hours Mon - Weds 9AM - 1PM

740 SE 182nd Portland, Oregon 97233
First Driveway Look for the Hope Center Sign

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